Medical Journal of Dr. D.Y. Patil Vidyapeeth

COMMENTARY
Year
: 2015  |  Volume : 8  |  Issue : 6  |  Page : 699--700

Case report: Clue for treasure hunt of evidence based medicine


Anupama Sukhlecha 
 Department of Pharmacology, M P Shah Govt. Medical College, Jamnagar, Gujarat, India

Correspondence Address:
Anupama Sukhlecha
Department of Pharmacology, M P Shah Govt. Medical College, Jamnagar-361008, Gujarat
India




How to cite this article:
Sukhlecha A. Case report: Clue for treasure hunt of evidence based medicine.Med J DY Patil Univ 2015;8:699-700


How to cite this URL:
Sukhlecha A. Case report: Clue for treasure hunt of evidence based medicine. Med J DY Patil Univ [serial online] 2015 [cited 2020 Nov 28 ];8:699-700
Available from: https://www.mjdrdypu.org/text.asp?2015/8/6/699/169877


Full Text

Case reports occupy a lower level compared to systematic review, meta-analysis and randomized clinical trials in the hierarchy of evidence-based medicine. [1] Published case reports provide important scientific observations and clinical insights, thus expanding our clinical knowledge. [2],[3] Many adverse reactions came into the limelight through case reports. The incidence of Kaposi's sarcoma in young homosexual men and shaking palsy (Parkinson's disease) were first reported in medical literature through case reports. [4],[5]

However, the Medical Council of India neither counts case reports as original research nor promotes medical teachers based on this kind of research. It is conceded that case reports are only observed evidence. Nevertheless, they are also scientific evidence. They should also be given credit while giving promotions, else there will be a time when health staff will simply ignore clinical reporting, and the world would miss important milestones in medicine. On the other hand, many "me too studies" - the so-called "original research" would come up in paid journals which do not add anything to what is already known. These journals survive in a symbiotic relationship with authors who get old studies (with minor modifications) republished as original research in return for the hefty fees paid to them. All this junk is added to scientific literature, the sole purpose being - "to seek promotion."

Appropriate credit should be given for each hierarchy of evidence and also for each type of publication. For example, systematic reviews/meta-analysis can be given a score of 10, randomized clinical trials as 8, descriptive studies as 6, case reports as 4 and so on. Monographs, editorials, teaching aids, etc., also can be given a score of 2. Reports of the conference, epidemic alerts, newer drugs and devices launched can also be given a score of 1. Having publications of different types always adds flavor to journal as it caters to different tastes. A monotonous journal with only original research articles of clinical trials will not attract a large audience.

On a case report website, case reports can be categorized in a way that analyzing them becomes easier. For example, for an adverse reaction to a particular drug-first the possible drug, dose, then possible class, then type of problem, the system involved and so on. It can also be done vice-versa. Little drops of water make a mighty ocean. There would be other patients in the world who would have suffered similar problem, and their problem would have been reported on the same or a linked website. In this way, all adverse reaction would come on the same platform and conclusions on whether to continue or discontinue the drug in the market would become quicker and much easier.

 Conclusion



Case reports help in advancing knowledge of rare diseases. They also act as first line of evidence for an adverse effect of medicine and, therefore, should not be ignored. Case reports should be given weightage while considering medical teachers for promotions and also while felicitating them on academic platforms.

References

1Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 2011;128:305-10.
2Carey JC. The importance of case reports in advancing scientific knowledge of rare diseases. Adv Exp Med Biol 2010;686:77-86.
3Cohen H. How to write a patient case report. Am J Health Syst Pharm 2006;63:1888-92.
4Gottlieb GJ, Ragaz A, Vogel JV, Friedman-Kien A, Rywlin AM, Weiner EA, et al. A preliminary communication on extensively disseminated Kaposi's sarcoma in young homosexual men. Am J Dermatopathol 1981;3:111-4.
5Goetz CG. The history of Parkinson's disease: Early clinical descriptions and neurological therapies. Cold Spring Harb Perspect Med 2011;1:a008862.